Member Care Advocate - Remote!

Job Details

Posting Date: 03-28-2025

Reference ID: 231911

Location: Lewiston, Maine

Work Location: REMOTE

Discipline: Insurance

Job Type: Contract/Contract-to-Hire

Salary Expectations/ Pay Rate or Range: $18.00-$19.50/hr (+.50 if bilingual) **based on location**

Job Description

Responsibilities/ Job Duties:

• Serve as the most visible representative of the company's mission to raise the standard of healthcare for everyone through fielding inbound member calls.
• Demonstrate a high level of empathy and drive with a strong interest in making a difference in patients lives.
• Communicate with both patients and providers on a variety of inquiries.
• Work with members and families who are going through challenging times.
• Demonstrate the ability to think critically and problem solve complex situations.
• Assist members with understanding their benefits and coverage.
• Interpret EOBs and be able to explain the difference between HSA, FSA and HRA.
• Explain and calculate out-of-pocket costs for member services.
• Explain and determine a member's deductible.
• Provide members with resources to providers in their area, both primary care and specialities, within their coverage.
• Field a variety of standard inquiries related to insurance claims, benefits information or enrollment, appeals, outstanding bills, and more.

Minimum Education and Experience Qualification Requirements:

• 5+ Years of Healthcare Customer Service Experience within an Insurance Enviornment - Explaining to members/patients their plan benefits and coverage for MEDICAL services (not medications, dental, vision, etc)
• 1+ Years of Experience working within a REMOTE Enviornment
• Insurance Knowledge - Knowing how to read a health plan is required (i.e. able to explain what a deductible, out of pocket cost, EOB, HSA/FSA/HRA is)

Schedule/ Shift:

• Department is open 7 days a week
• Offers some M-F schedules with hours ranging from 5am PST - 12pm PST
• Training is 10 weeks - M-F (will be required to pass testing throughout the training period)
• Training Schedule = M-F, 7am-4pm PST

Benefits:

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances)

• Health Benefits / Dental / Vision (Medix Offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s).)

• 401k (eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1)

• Short Term Disability Insurance

• Term Life Insurance Plan

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.